Dollars & Sense and Dr. Ichiro Kawachi on Inequalities of Health & Wealth
Dollars & Sense is a bimonthly magazine “of economic justice” produced by the Economics Affairs Bureau, Inc, a not-for-profit publisher in Boston. EAI also publishes a series of “Real World” books which cover a variety of topics such as macroeconmics and political economy. All the issues of Dollars & Sense are available on the web and – together with their blog – provide some welcome critical orientation on the current economic crisis. Interested readers may want to look at Larry Peterson’s series: The Subprime/Securitization Market Panic: A Guide for the Perplexed.
Earlier this year D&S interviewed Ichiro Kawachi, of Harvard’s School of Public Health reagarding the effects of income inequality on health. In this interview Dr. Kawachi discusses his views on how both absolute income levels and relative inequality affect health:
“Most obviously, income enables people to purchase the goods and services that promote health: purchasing good, healthy food, being able to use the income to live in a safe and healthy neighborhood, being able to purchase sports equipment. Income enables people to carry out the advice of public health experts about how to behave in ways that promote longevity.
But in addition to that, having a secure income has an important psychosocial effect. It provides people with a sense of control and mastery over their lives. And lots of psychologists now say that sense of control, along with the ability to plan for the future, is in itself a very important source of psychological health. Knowing that your future is secure, that you’re not going to be too financially stressed, also provides incentives for people to invest in their health Put another way, if my mind is taken up with having to try to make ends meet, I don’t have sufficient time to listen to my doctor’s advice and invest in my health in various ways.
So there are some obvious ways in which having adequate income is important for health. This is what we call the absolute income effect—that is, the effect of your own income on your own health. If only absolute income matters, then your health is determined by your income alone, and it doesn’t matter what anybody else makes. But our hypothesis has been that relative income might also matter: namely, where your income stands in relation to others’. That’s where the distribution of income comes in. We have looked at the idea that when the distance between your income and the incomes of the rest of society grows very large, this may pose an additional health hazard.”
Dr. Kawachi’s interview updates the concept that relative income inequality, in addition to absolute levels of wealth, is an important determinant of health. This idea has been debated for several decades in Britain. It had been hoped that the introduction of the National Health Service would eliminate health disparities by providing universal and equal access to care. However the publication of the Black Report in 1980 revealed that health inequalities persisted in the “socialist” NHS. In response Ruskin College Oxford and the Socialist Health Association prepared a series of reports. The fourth, Income and Health, was published in 1991. It was written by Allison Quick and Richard Wilkinson and began:
“The key argument of this report can be stated in three sentences. Overall health standards in developed countries are highly dependent on how equal or unequal people’s incomes are. The most effective way of improving health is to make incomes more equal. This is more important than providing better public services or making everyone better off while ignoring the inequalities between them.’
From this argument derives a socialist commitment to income equality. Interested readers may want to look at the Socialist Health Association’s Health Inequalities Policy Statement for the practical implications of this viewpoint. Of course, “socialism” was recently used during the US Presidential campaign in an attempt to “smear” President-Elect Obama. So the concept of increasing income equality is, frankly, off the table. And one does not think to ask if income and social inequality are both not intrinsic and necessary in a capitalist economy.
Dr. Kawachi’s interview updates the thesis of Quick and Wilkinson with modern evidence. He cites the 2006 JAMA study showing that Americans – with higher levels of income – are less healthy than our British counterparts and he suggests some more technical solutions designed to bring economics to the service of health, such as Health Impact Assessments (HAI).
I have been disturbed by the emphasis on the psychological impact of health inequality. This was a prominent part of the recent PBS series Unnatural Causes. One cannot help escape the feeling that the practical implications of this theory are not the promotion of income equality, but rather the teaching of the exploited to relax and accept their fate.
posted by Matt Anderson
It is good to see the Black Report in prespective with the relationship between health and wealth – and coming from a country that is suppose to have been developed with the help of international organisations – Georgia. It is clear to it me that everything is relative – and instead of bridging the gap between the have and have nots – it has has actually widened and people are less healthy than before. At the same time millions of dollars in developmental aid pours into the country with a political agenda attached – unfortunately development is not to reduce income inequalities and improving living standards but serves as a poltiical payoff to those that support the foreign policy of the country that provides in the money (at least in most instances)